EARLY DETECTION AND REPERFUSION FOR CEREBRAL THROMBOEMBOLISM AFTER CARDIOVASCULAR SURGERY

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The objective of this study was to investigate the role of immediate cerebral angiography and local thrombolysis for stroke after cardiovascular surgery. Patients and methods: Aggressive approach including early cerebral angiography and intraarterial administration of fibrinolytic agent for stroke after cardiovascular surgery was employed. Seven patients who had stroke after surgery among 1244 patients who underwent cardiovascular surgery were enrolled this investigation. Results: In-hospital cerebral thrombosis or thromboembolism occurred 3 to 9 days (average: 6.3±2.7 days) after surgery. Immediate cerebral angiography revealed cerebral embolism in 4 and cerebral thrombosis in 3 with occlusion or stenosis of intracranial arteries. Local, intraarterial administration of a thrombolytic agent was carried out in 5 patients with cerebral thromboembolism (n=4) or thrombosis (n=1), and complete recanalization of the occluded artery was obtained in 3 patients (60%) and partial recanalization in 2 patients (40%). Additional angioplasty for basilar artery stenosis was performed in one patient. No patients exhibited bleeding complication. All patients survived with moderate or full functional recovery. Conclusions: Immediate cerebral angiography with/without local thrombolysis may improve functional outcome and survival in patients with postcardiotomy cerebral thromboembolism.

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